Chronic Kidney Failure in Dogs Community
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13602926 tn?1458507560

It has been nearly a year and the last few days have been the worst...

I haven't posted in a while. My yorkie Pepsi, was diagnosed with Kidney failure and Heart Disease (Murmur) April 2015. I was told he had a year, at most. He is on Pimobendan and Enalapril for his heart and Alum. Hydrox for his kidneys.
I was able to get his numbers down and had a great Internist with OSU Vet School when I lived in Ohio.
In August I moved in California from Ohio. In my opinion my new vet is too casual with Pepsi's care. The only Internist I found is with UC Davis Vet School and they will only take him by referral of my vet, which my vet thinks is not necessary.
I was okay with this so far. Pepsi was improving, running, barking, and eating great. He had gone from 7 lbs to a little over 4 but I got him up to nearly 5 lbs.
His last numbers were taken 4 months ago: BUN 93 mg/dL, Creatinine 2.0 mg/dL. I did not get a blood pressure reading then. In April 2015 his BP was 120 mm (Hg systolic).
Then 3 days ago he started throwing up. I thought maybe it was because I started adding a new Low Phos food that I found at my local pet store a few days earlier. It is all natural food (lamb, carrots, potatoes, green beans) and added vitamins and comes frozen. I have since stopped.
Now I have to syringe feed him a mash of KD and water with phos binder. Sometimes I add white potatoes or crushed vanilla wafers for added calories. I feed him one ounce of this mash every 2-3 hours. Occasionally he will eat KD Stew when I hand feed him. He would throw up about 6 hours after eating (not much, sometimes just dry heaves) so I upped his phos binder. He is suppose to take 1 ml. 3 times a day, I give him 1 mil 5 times a day. If he eats on his own, I dilute the phos binder with water and syringe feed it to him after his meal. He has started to not eat when the phos binder is on his food. Since increasing the phos binder he has not thrown up (24 hours so far).
He still drinks plenty of water. I usually place the bowl in front of him and he will drink sometimes he will freely walk to the bowl.
He sleeps more and is wobbly when he walks. He looses his balance when he lifts his leg to urinate so sometimes he will squat.
I questioned my vet whether I should continue with the Enalapril because it affects his kidneys. He said to continue even though he does not have an issue with high blood pressure because it is the norm with heart conditions to take it. I stopped for a few days but got worried I was doing the wrong thing and started back up. I read another post where their Internist told them to immediately stop the Enalapril. I think I will try stopping again.
I am going to call the vet tomorrow (Monday) and ask for the referral to the Internist.
4 Responses
13602926 tn?1458507560
Update: I got a new blood work panel. His BUN has increased to 258, Creatinine 2.9, Phos 5.0

He was dehydrated so they gave him Sub Q fluids yesterday at 3 pm and he has not drank water since. I syringed him 10 ml of water last night.

He is still not eating. I find it odd that he is fine when I syringe feed him KD Original with water and phos binder, but when he free feeds with KD Stew and phos binder, he throws up a few hours later (I see the stew contents). His phos levels are normal but I was told to give him the phos binder as a precautionary.

Vet recommends IV fluids next. Says his high BUN may be due to his dehydration and me feeding him boiled chicken once a day for the last few weeks. Also told his heart sounds strong, less murmur, so told to stop pimobendan and enalapril.

Precision PSL level high, 794 (normal range 24-140) so thought he may have pancreatitis.

He recommends IV fluids and ultrasound...
update: Had talk with vet about sending to an internist. He was reluctant and I think upset that I would want another opinion but forwarded file to a specialist.
Specialist ran BUN/Creatinine, 242/3.5, still very high. Still waiting for PLI test results (pancreatitis). He started him on Pepcid, Cerenia, and Mirtazapine, stop the Enalapril, and continue with Pimobendan. His appetite returned 3 hours after taking the new meds. I spread out 3 small meals over 6 hours even though he kept begging because I did not want him to eat too much too fast. Ultra sound showed normal pancreas and showed expected progression in kidney damage. He gave SubQ and recommends IV, says even though 2 days of SubQ have shown improvement in appetite he still recommends IV for 2 days, possibly 3.
They said if he refuses to eat while on IV he would be given a feeding tube, they do not hand feed. I am scared. My baby is a picky eater and a very nervous dog. I fear he will deteriorate without hand feeding. I know it is the best thing to do but family are pressuring me to stop. They say he is old, accept it, and stop spending the $$. As you all know it gets expensive, if the IV treatment was $200 there would be no issues, but it will be $2000. I don't want to make a decision on his comfort because of $$, I can afford it, I want to do it, so hard to decide when it is time to stop.
sorry, comment repeated for some odd reason...
Avatar universal
Hello there. I know how hard is to deal with that disease. On Valentine's Day I lost my baby Lili, she was also a Yorkie. She was 12 and was diognosed with chronic kidney disease 10 months ago and now she is gone. I miss her a lot but I couldn't save her.

You can read my stories and questions here on blog. It might be helpful for you?

Please remember that we are here to listen you.

17638038 tn?1527635265
I know exactly how you feel. I have spent so much $$ on my Yorkie Poo in the last couple of months, but honestly I would not stop fighting until you feel it's time. 2000 dollars for IV??? That seems like an extremely high price for three days of IV. Would you be open to trying another Vet for the IV Fluids?  
My Yorkie Poo stayed in the hospital for three days on IV and his numbers went down and he was so much better after that. I went up there one day and force fed him on my own. Can you do that for your dog while he is at the Vet? My bill was 530.00 when I picked him up.
Also, I don't know exactly what you are giving your dog, but I give Dior a Pepcid, Dr Harvey CO Q10, B 50 Complex, Sub Q Fluids every other day, and I feed him Royal Canin Renal Support, and a cerenia when he is nausea. I also go to Whole Foods and get fresh water. I am currently using Epakitin Supplement. I did Aluminum Hydroxide last month.

Hope that helps!! =)
I think you should wait for Tony to respond. He is a very supportive and well executed in CKD.

I had to put to sleep my Yorkie Lili on Valentine's Day because she didn't responde well for all the medications you mentioned.
She was 12.
her blood work was really bad two days before Valentine's Day and I couldn't watch her suffer anymore. Terrible decision but I couldn't help her anymore.
I also spend easily $4k and it wasn't working for my dog as the vets wished.

Remember every dog is unique and it might work for your doggy great.

Just wait for Tony's suggestions. He is really well known in CKD.

13602926 tn?1458507560
Thank you everyone. Pepsi has responded positively to the new meds and SubQ. He no longer vomits, and now eats 1/2 cup Royal Canin Renal a day. Since it has so much rice it is very "sticky", he has an issue with it sticking to the roof of his mouth. I roll the food into small marble sized pieces and let them dry on the counter for a few hours, he can swallow these without chewing.

My primary vet has "dis-owned" Pepsi. Initially my vet had recommended IV at his office for the day (he is not open 24 hours) and I would take him home nights but now he says since I went to the Internist he will not do this. The Internist wants Pepsi to start 2-3 days of IV but Pepsi has done so well with SubQ I want to wait a week and do another blood panel to see if IV's are still necessary, and since the Internist recommends IV my primary vet will not assist me with SubQ either. The Internist showed me how to do this and I purchased the fluids, needles. He is drinking on his own now and seems to being doing well with new meds. Internist wants me to give him 75 cc's everyday. I think this extreme, and want your opinions. He weighs 4 lbs. I want to give him SubQ every other day or maybe when he needs it.

I too think $2000 for 2-3 days of IV is extremely high. It covers Nursing Care, Catheterization, IV set up, Fluid Therapy, Medication, and blood work ups every 12 hours. I checked 2 other 24 hour facilities. One would not take unless primary vet refers (and I doubt mine will) so I could not get price and another is very similar in price. I was told visitation is from 11 am to 11 pm and I am welcome to visit and hand feed him myself if that is a concern of mine (which it is).
Hi.....I thought it was your primary vet charging you 2,000. That price is pretty comparable to the price I pay when I go to the internist in my area. It's a lot cheaper when I go to my primary vet, but the internist has 24 hour care and the last time I took Dior there, my bill was 1,600 and he spent one night on IV's, but that also included all the medication they were giving him and blood work. He felt so much better after doing 24 hours of IV. It's great to hear that Pepsi improved from the IV Fluids and that he is eating the Royal Canin Renal Support food. I have to make round balls of the food to get dior to eat it. I've also fed him the Purina Kidney Canned Food, which he liked too. I'm not sure about the cc for a dog that is 4 lbs. Dior is 12 pounds so I give him more than that. I would wait for Tonys suggestion.
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